Client

Birmingham Children’s Hospital NHS Foundation Trust (BCH) provides a full range of medical services
for children and young people in and around the West Midlands. It’s one of the leading paediatric teaching hospitals
in the UK and a recognised centre of excellence for children with cancer, cardiac, renal, and liver disease.
It offers 220 beds with nine operating theatres, a 22-bed paediatric intensive care unit, and an emergency department dealing with over 45,000 cases annually.

Challenge

The hospital creates comprehensive paper-based records for every patient that attends the emergency department.
Each comprises a booklet containing up to 15 pages of data documenting the circumstances of the medical emergency,
patient injuries, test results, treatment, and ongoing care plans. These records were being filed in storage boxes
and held on-site for six months and then transferred to an Iron Mountain records management facility for long-term safekeeping.

With the emergency department typically seeing up to 200 patients each day, the records were piling up,
occupying valuable hospital space that could have been better used for clinical purposes. Furthermore, with up to 400 patient files stored
in each box and up to 100 boxes kept in the hospital storage facility at any time, document retrieval was far from straightforward.

Sue Hobday, Head of Clinical Records and Clinical Coding at BCH, explains: “If a child attends the emergency department more than once,
something that unfortunately occurs all too often, we need to access their historic files. Finding the records was time consuming and unproductive.
We decided it was time to move to an electronic patient records system.”

Solution

To deliver immediate benefit, the historic patient records would have to be scanned to enable instant access.
The digital files would also need to be created in a form suitable for upload into an electronic patient records (EPR) system
at some point in the future. BCH determined that historic records going back at least 12 months would need to be digitised,
so a service provider was sought for the significant back-scanning project.

“It’s so much more efficient. Going forward, it means that our staff will save a great deal
of time as they will no longer need to go searching for paper files.”
Sue Hobday
Head of Clinical Records and Clinical Coding Manager
Birmingham Children’s Hospital
NHS Foundation Trust

Fortunately BCH didn’t need to look far. Sue Hobday says: “We had been using Iron Mountain
for the storage of our clinical records and we already had a four-year framework contract in place.”
Guided by Iron Mountain document management specialists, BCH developed a plan for the back-scanning project.
“Iron Mountain offered us a cost-effective comprehensive solution for scanning and storage,” adds Sue.
“The bonus was that Iron Mountain was already holding some of the records that we needed to scan,
which would improve the efficiency of the process.”

A specification was created for the metadata needed to identify each file.
Once files are scanned, an advanced optical character recognition system matches the scanned file
to the patient’s unique hospital number and enables the creation of other metadata fields to complete the record.
The scanned patient files are then uploaded for hosting on the Iron Mountain digital records centre for images (DRCI).
The contract provides for 500GB of storage capacity, more than sufficient for many years to come.

Up to 25 authorised BCH staff are able to access patient files through a secure web-based portal
using a patient’s name and/or hospital number. For added patient confidentiality, as well as normal access controls,
patient records can only be printed from the Iron Mountain DRCI by a strictly controlled group of accredited BCH staff.

The back scanning project involved around 40,000 patient records which were all digitised at the Iron Mountain specialist facility
at Stone in Staffordshire. The scanning process is certified against the requirements of BS10008, which means that images
are of a sufficient quality and integrity to be used in a court of law.

During the scanning process Iron Mountain provided a scan-on-demand service if any patient file in its custody was required urgently.
“The scan-on-demand service during the back-scan phase was fantastic,” says Sue Hobday. “The team couldn’t have been more responsive to individual requests.”

Going forward the plan is for patient records to be stored on site for between two and four weeks,
before being collected by Iron Mountain for scanning, hosting, and archiving of the hard copies.

Value

Clinical teams at the hospital now have almost instantaneous online access to patient files for all previous emergency department admissions.
“It’s so much more efficient,” confirms Sue Hobday. “Going forward, it means that our staff will save a great deal of time
as they will no longer need to go searching for paper files.”

The new process will help improve patient care as multiple admissions are far easier to spot.
Moreover, in the event of child protection concerns, patient records will be available to investigation teams in an instant,
enhancing the speed and quality of patient welfare decision-making.

Information security has been improved too. The Iron Mountain process provides a full chain of custody
as well as enhanced governance through a complete audit trail of individuals who have viewed or printed patient files via the DRCI.

The back-scanning project also provided the opportunity to improve the indexation of hospital paper-based records so that hard copy files
are easier to locate should they ever be needed. And, with a process now in place for the routine ongoing scanning and off-site storage of new patient records,
the space previously allocated for the storage of paper-based records at the hospital is now available for more productive use.

Sue Hobday sums up: “Iron Mountain has been very supportive and responsive throughout the project. We couldn’t have asked for more.”